717: Neurologist: The Real Cause of Brain Disease — and How to Protect Yourself | Dr. David Perlmutter

Let's talk about mental health now and the connection between this M1, M2 and how that fits in.

First, I would say that we have, uh, gained an understanding that, uh, many of our mood disorders like, uh, anxiety and, uh, certainly major depressive disorder, have a powerful inflammatory component, and as such we assume therefore that, uh, this is going to shift those microglial cells from M2 to M1.

This is relatively new.

I mean, there are now, you know, books written, uh, that look-- One is called Brain Energy, that looks at the energetics of what's going on in the brain, in the, in the neurons and in the microglia from an energetic perspective, uh, really focusing on the idea that when we shift away from mitochondrial function, we're setting the stage for increased brain inflammation and polarization away from being helpful of our microglial cells.

So it's a very, very good question, very good point.

Why, why so? Because it takes us out of the realm of being solely dependent upon drugs to realizing that lifestyle interventions may play a role here.

Now, we've known for years that there is m- uh, there can be some significant benefits of lifestyle intervention in patients, for example, with chronic depression, uh, with respect to dietary changes and exercise and paying attention to sleep, for example.

What are the mechanisms? Well, inflammation, uh, improved, uh, uh, insulin sensitivity, uh, increased production of new brain cells, which seems to be something very important in the treatment of depression.

So we move away then from this idea of lack of serotonin is the cause of depression to these other issues that, you know, uh, researchers and clinicians like Dr. Uma Naidoo at, at Harvard, uh, and Christopher Palmer, the author of the book that I just mentioned, have made so clear to us.

And I will re- refer back to a, a earlier part of our discussion where we talked about the imaging of the activated microglial cells, that TSPO imaging, uh, that is seen to be lit up, i.e., microglial cells have shifted from M2 to being destructive M1, as demonstrated by how these TSPO images light up in, uh, major depression, telling us what? This is a shift in the immune function in the brain, and what do we know? We know that that can be brought on by the metabolic changes that we've been talking about

And this ties back to another earlier part of the chat when we talked about different neurodegenerative conditions, Parkinson's, Alzheimer's.

I asked you about now that we have this information, how you look at maybe there being a common thread there.

Now we can bring mental health challenges in.

Do you look at them under the same umbrella?

Absolutely.

In fact, I unpack, as you know, I unpack that quite a bit in the book.

You know, Brain Defenders is not just about Alzheimer's.

It's about mood disorders.

It's about, um, autism spectrum disorder.

And it's about Parkinson's and really, you know, a, a, a global approach, uh, to brain health.

And I, and I think it's so important that we drive home the point that depression is a brain-related disease, that mood disorders, psychiatric issues are related to the brain.

Why am I emphasizing this? It's because I had an interview the other day with a Dr.

Daniel Amen, and he does SPECT imaging of individuals with brain trauma, Alzheimer's, and mood disorders like depression as well.

And he said something very interesting.

He said, "Psychiatrists are the only discipline or specialty that doesn't study the, the very organ that's involved in their specialty, the brain." They don't image the brain.

Let's talk about mental health now and the connection between this M1, M2 and how that fits in.

First, I would say that we have, uh, gained an understanding that, uh, many of our mood disorders like, uh, anxiety and, uh, certainly major depressive disorder, have a powerful inflammatory component, and as such we assume therefore that, uh, this is going to shift those microglial cells from M2 to M1.

This is relatively new.

I mean, there are now, you know, books written, uh, that look-- One is called Brain Energy, that looks at the energetics of what's going on in the brain, in the, in the neurons and in the microglia from an energetic perspective, uh, really focusing on the idea that when we shift away from mitochondrial function, we're setting the stage for increased brain inflammation and polarization away from being helpful of our microglial cells.

So it's a very, very good question, very good point.

Why, why so? Because it takes us out of the realm of being solely dependent upon drugs to realizing that lifestyle interventions may play a role here.

Now, we've known for years that there is m- uh, there can be some significant benefits of lifestyle intervention in patients, for example, with chronic depression, uh, with respect to dietary changes and exercise and paying attention to sleep, for example.

What are the mechanisms? Well, inflammation, uh, improved, uh, uh, insulin sensitivity, uh, increased production of new brain cells, which seems to be something very important in the treatment of depression.

So we move away then from this idea of lack of serotonin is the cause of depression to these other issues that, you know, uh, researchers and clinicians like Dr. Uma Naidoo at, at Harvard, uh, and Christopher Palmer, the author of the book that I just mentioned, have made so clear to us.

And I will re- refer back to a, a earlier part of our discussion where we talked about the imaging of the activated microglial cells, that TSPO imaging, uh, that is seen to be lit up, i.e., microglial cells have shifted from M2 to being destructive M1, as demonstrated by how these TSPO images light up in, uh, major depression, telling us what? This is a shift in the immune function in the brain, and what do we know? We know that that can be brought on by the metabolic changes that we've been talking about

And this ties back to another earlier part of the chat when we talked about different neurodegenerative conditions, Parkinson's, Alzheimer's.

I asked you about now that we have this information, how you look at maybe there being a common thread there.

Now we can bring mental health challenges in.

Do you look at them under the same umbrella?

Absolutely.

In fact, I unpack, as you know, I unpack that quite a bit in the book.

You know, Brain Defenders is not just about Alzheimer's.

It's about mood disorders.

It's about, um, autism spectrum disorder.

And it's about Parkinson's and really, you know, a, a, a global approach, uh, to brain health.

And I, and I think it's so important that we drive home the point that depression is a brain-related disease, that mood disorders, psychiatric issues are related to the brain.

Why am I emphasizing this? It's because I had an interview the other day with a Dr.

Daniel Amen, and he does SPECT imaging of individuals with brain trauma, Alzheimer's, and mood disorders like depression as well.

And he said something very interesting.

He said, "Psychiatrists are the only discipline or specialty that doesn't study the, the very organ that's involved in their specialty, the brain." They don't image the brain.